Role of port incision site and intraperitoneal Inj. Lignocaine 2% instillation on post-operative pain relief after laparoscopic surgery

Introduction: Laparoscopic surgery, in particular, has seen tremendous advances. Breakthroughs in video technology, instrumentation, adhesion prevention, and computer-enhanced technology have certainly allowed surgeons to routinely perform a number of procedures endoscopically rather than by laparotomies. Aim and Objectives: To evaluate role of lignocaine 2% instillation at post site and intraperitoneal on pain relief. Methodology: 40 patients who were enrolled in present study conducted at Dhiraj hospital, Smt. B. K. Shah Medical Institute and research centre, Pipariya from 1st August 2020 to 30th October 2021. They were randomly divided in to 2 groups A and B. In patients of Group A post-operative Inj. Lignocaine 2% were given at port site and intraperitoneally while patients of group B were managed as routine. Patients in both groups were given pain score and score was recorded and compared at 1, 4 and 10 hours postoperatively. Results: Total 40 patients were enrolled out of which 22 patients were Male and 8 patients were female; mean age group was 31-40, most common surgery was laparoscopic cholecystectomy. Pain score was more in group B as compared to group A. Conclusion: Port site and intraperitoneal instillation of injection lignocaine reduces post-operative pain following laparoscopic surgeries

Thiopentone sodium versus propofol for anaesthesia in modified electro-convulsive therapy (ECT)

  Objectives: To compare the effects of thiopentone sodium and propofol as an intravenous anaesthetic agent in modified ECT. Methods: 100 patients of ASA I & II grade were randomly assigned in to two groups. Both groups were premedicated in ususal manner. Patients in Group A were induced with inj. thiopentone sodium 3-5mg/kg and in Group B inj. Propofol 1.5-2mg/kg. Then, Inj. Succinyl choline 0.5-1mg/kg was given. Patients were ventilated with 100% oxygen with bain circuit and mask. Shock was given after putting bite block. Patients were again ventilated till spontaneous respiration after seizures. Results: Propofol is better induction agent as compared to thiopentone sodium in terms of faster induction, better haemodynaemic stability, no significant effect on seizure duration, early recovery without any side effects. Conclusion: Propofol in the dosage of 1.5-2 mg/kg body weight intravenously can be safely used for modified ECT in ASA grade I and II pateints. Fast, smooth induction, better hemodynamics, early smooth recovery, antiemetic property and uncompromised therapeutic outcome makes propofol as an agent of choice for day care procedure. Though there is reduced seizure duration with Propofol as compared to thiopentone, there is no effect on outcome of the therapy or effectiveness of ECT

Effects of Ketamine Gargle for Post-operative Sore Throat, Hoarseness of Voice and Cough Under General Anaesthesia- A Randomised Control Study

Introduction: Majority of the patient undergo endotracheal intubation for various time duration, when given general anaesthesia. Injury in airway mucosa or vocal cords due to endotracheal intubation can be a contributing factor. Ketamine without affecting local healing process has an antiproinflammatory effect as it limits exacerbation of systemic inflammation. Aim: To study the role of ketamine gargles as a pharmacological measure in order to attenuate POST, HOV and cough followed by endotracheal intubation during surgeries under general anaesthesia. Materials and Methods: A randomised controlled study was carried out for a duration of 22 months from the institutional ethical committee (Study Approval No. SVIEC/ON/MEDI/ BNPG18/D19046), on 50 patients of American Society of Anaesthesiologists (ASA) grade I and II. They were allocated into two groups of 25 patients. Group (K): ketamine 50 mg in 29 mL 0.9% normal saline and Group (C): 30 mL 0.9% normal saline. Patients were advised to gargle for 30 seconds just 5 minutes prior to induction of anaesthesia. Patients were intubated with appropriate size of the endotracheal tube and were extubated when fully awake and conscious. Pateints were shifted to postoperative ward and were kept in propped up position with oxygen. Pateints were assessed at 1,2,4,24 hours for incidence of POST, HOV and cough. Assessment was made as per the 4 point scale grading system. The statistical analysis was performed using unpaired t-test, p<0.05 considered statistically significant. Results: In terms of POST grading in both K and C groups p-value was statistically significant (p<0.05) at 1 and at 2 hours postoperatively. In terms of HOV, in group K voice quality issues were reduced till 24 hours, (p<0.05). In terms of cough, in group K there was a significant reduction in complaints of cough till 4 hours postoperatively, (p<0.05). Conclusion: Ketamine gargles is effective in attenuating POST and cough till 2 hours and HOV till 4 hours postoperatively in patients following endotracheal intubation

Supraclavicular versus infraclavicular Brachial Plexus block

BACKGROUND: &nbsp;Of the various modalities of achieving surgical anaesthesia of the forearm, brachial plexus block by injecting local anaesthetic is considered highly beneficial and practical. Supraclavicular and infra-clavicular approaches of brachial plexus blocks provide comprehensive anaesthesia for surgeries of the forearm. The primary outcome measured was the comparison of two blocks with respect to sparing of any dermatome, whereas the secondary outcomes measured were block performance time, duration of analgesia, and complications associated with each technique. METHODS: 150 patients belonging to the American Society of Anesthesiologists (ASA) physical status I and II in the age range of 18–80 years scheduled to undergo surgeries of the forearm were divided into two groups: Supraclavicular (SCB group) and Infraclavicular (ICB group) of 75 each. Both the blocks were given by 30 mL of 0.25% injection Bupivacaine using a 22G, 5 cm insulated needle and nerve locator. Both the groups were compared with respect to sparing of dermatomes, block performance time, duration of analgesia and complications like Horner’s syndrome, vascular puncture, and pneumothorax. RESULTS: Block performance time was similar in both the groups. Duration of analgesia was comparable among the two groups.&nbsp

Comparison of haemodynamic response to induction with propofol versus etomidate in patients scheduled for elective surgery

Introduction: Laryngoscopy and endotracheal intubation are harmful stimuli that can produce adverse response in the cardiovascular, respiratory and other physiological systems. These changes are reflected in haemodynamic parameters which can be fatal for patients with low cardiac reserve and may alter the balance between myocardial oxygen supply and demand and as a result, myocardial ischemia can be precipitated. This observational comparative study was conducted to compare the haemodynamic effects of Propofol and Etomidate during induction of general anaesthesia in patients scheduled for elective surgery. Materials and Methods: 58 patients of American Society of Anaesthesiologists (ASA) physical status &nbsp;I and II of age group 18-60 years scheduled for elective surgeries under general anaesthesia were randomly assigned in two groups (n=28). Group P received injection Propofol (2.5mg/kg) and group E received injection Etomidate (0.3mg/kg) during induction. Hemodynamic parameters were recorded at various time intervals. Statistical analysis was done using software (MedCalc Version 20.014). P value was considered significant if p £ 0.05. Results: Demographic profile was comparable in both the groups. Hemodynamic parameters at baseline and after premedication were comparable